Incidence of Rotator Cuff Tears and Surgery Increasing
The incidence of rotator cuff tears increases with normal degenerative processes that occur during aging, with 4% of asymptomatic patients under the age of 40; and 54% of patients 60 or older demonstrating either partial or complete tears found on MRI scans.
According to the American Academy of Orthopaedic Surgeons, between 1998 and 2004, over 5 million physician visits were attributed to rotator cuff problems: a 40% increase over the span of twenty years, suggesting that this upward trend will only advance with a rapidly aging population.
Given an older population and the increase in rotator cuff repair (RCR), the incidence of poor surgical outcomes is bound to increase. The overall complication rate from arthroscopic rotator cuff repair stands at approximately 10%. Complications associated with arthroscopic RCR include disruption of the movement structures (bony, musculature, etc.) stabilizing the shoulder, infection, foreign body reaction, stiffness and nerve injury.
Revision Surgery More Complicated than Primary with Poorer Outcomes
Revision or repeat RCR is generally more complicated than the initial surgery, hampered by poor tissue quality, retained hardware, unrealistic expectations on the part of patients, as well as a myriad of other post-operative complications. Causes for failed RCR tend to be multi-factorial but can be categorized by: surgical complications, misdiagnoses, technical errors, failure to heal and traumatic failure.
Now, a study from the Orthopaedic Research Institute in Sydney, Australia, provides strong cautionary evidence, reaffirming other studies showing that long-term outcomes associated with revision RCR are not as successful as first-time surgery.
“According to our results, patients with revision arthroscopic rotator cuff surgery had gained short term (six months post operatively) functional and clinical improvements. However, these gains pretty much disappeared by two years following surgery,” said lead researcher, Aminudin Mohamed Shamsudin, MD.
Shamsudin and his team surveyed 360 primary or first-time arthroscopic rotator cuff surgery patients, comparing their functional and clinical outcomes with those of 50 revision cases. The revision group patients were, on average, three years older than the primary group while the primary group tended to have larger rotator cuff tears.
Re-Tear Rate in Rotator Cuff Repair
Two years after surgery, the primary group reported less overall pain at rest as well as with overhead activities compared to the revision group. The re-tear rate for the primary rotator cuff repair was 16% at six months and 21% at two years while the re-tear rate for the revision rotator cuff repair was significantly higher: 28% at six months and 40% at two years. The increase in re-tear rate in the revision group at two years was associated with increased pain, impaired overhead function and less overall satisfaction with shoulder function.
“Further studies are needed to identify ways to improve long-term outcomes following revision arthroscopic rotator cuff surgery. However, our results do highlight the long-term success of primary rotator cuff surgery and may help patients understand the realistic expectation of the outcomes of revision arthroscopic rotator cuff surgeries,” said Shamsudin.
This new study parallels prior research demonstrating consistently inferior outcomes with revision surgery compared to primary RCR. Findings underscore the need for surgeons to exercise best clinical judgment and judicious restraint when making the decision to undertake RCR as well as using maximum caution during and post-surgery, all while preparing patients for realistic outcomes.
